| NPI | 1225609092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: OH 0002244) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 175494) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.180850) | |
| 101YM0800X Counselor, Mental Health | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2021-07-02 |
| Last Update Date | 2022-05-31 |